1952483323 NPI number — BZ GASTROINTESTINAL PA

Table of content: (NPI 1952483323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952483323 NPI number — BZ GASTROINTESTINAL PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BZ GASTROINTESTINAL PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952483323
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 BRICK RD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
MARLTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-983-1333
Provider Business Mailing Address Fax Number:
856-983-9292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 BRICK RD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
MARLTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-983-1333
Provider Business Practice Location Address Fax Number:
856-983-9292
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAGASIC
Authorized Official First Name:
MARIO
Authorized Official Middle Name:
V
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
856-983-1333

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  MA56820 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RG0100X , with the licence number: MA58049 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: D6195 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 30528000 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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